Week 6 - Gerd/hernia & esophageal CA Flashcards
What are the lifestyle strategies to prevent GERD & Hiatal Hernia symptoms?
CPAP for sleep apnea
Avoid smoking and drinking alcohol
What are the nutritional strategies to prevent GERD and Hiatal Hernia symptoms?
Eat several meals a day
stop eating 3 hours before bed
avoid irritating foods (peppermint, chocolate, fatty foods, caffeine, carbonated drinks, spicy/acidic foods)
What are the non-surgical interventions for esophageal cancer?
Nutritional & swallow therapy to help support chemo, radiation, surgery
soft food
daily weights
sit upright
How do we care for someone pre-op for Nissen fundoplication surgery?
- encourage weight loss
- encourage smoking cessation
How do we care for someone post-op for Nissen fundoplication surgery?
- regular post op care
- HOB up to reduce respiratory complications
- Early ambulation
- DB&C Q 1hr - pain control meds
- NG
- Gradual diet progression
How do we care for someone pre-op esophagectomy surgery?
smoking cessation
nutritional support
excellent oral care
respiratory rehab (strengthen respiratory system for post surgery)
What is the highest priority post-op esophagectomy surgery?
Respiratory care is highest priority
what drugs do we use to control the symptoms of GERD & Hiatal hernia?
Antacids
PPIs
H2 receptor blockers
What is GERD (Gastroespohageal Reflux Disease)?
Backward flow of gastric contents into esophagus
What are the 4 things GERD results from?
- LES incompetence d/t food/meds
- Hiatal hernia
- Increased intraabdominal pressure (preggers/obesity/ascities)
- Inflammation
GERD can lead to 5 other disorders (dx), what are they?
- Barret’s esophagus (pre-cancerous d/t repeated acid)
- Respiratory complications - aspiration (wheezes = bad)
- Esophagitis
- Dental decay
- Hemorrhage
What are the symptoms of GERD?
- Dyspepsia
- Regurgitation
- Dysphagia
- Odynophagia
- Coughing
- Chest pain
- Pyrosis
- belching
What are the 2 types of Hiatal Hernia?
- Sliding hiatal hernia (smaller)
- Paraesophageal (rolling) Hiatal Hernia (large)
What are the symptoms of Hiatal Hernia similar too ?
GERD
also can be asymptomatic
What drugs do we want to avoid with GERD and hiatal hernia and why?
-drugs that lower LES pressure
- oral contraceptives
- anticholinergic drugs
- sedatives
- NSAIDs
- nitrates
- CCB (calcium channel blockers)
What is typically a last resort for GERD & Hiatal Hernia ?
surgery - nissen fundoplication
What is sliding hiatal hernia?
whole top part of stomach Slides up into thoracic cavity (laying down)
resolves when person sits/stands
What is rolling hiatal hernia (paraesophageal)?
Stomach is in right position but a part of it has huge bulge that pokes through (herniated) through diaphragm
How do we know if the fundoplication is too tight?
person can’t belch or has dysphagia for week/months (this is not normal)
Should someone who just had Esophagesctomy be laid flat?
no never!
semi-fowlers or high-fowlers only
What is a complication to monitor for post esophagesctomy?
Anastomoni leak - into mediastinis then causes mediastinitis = infection/shock
How do we prevent mediastinitis post esophagesctomy ?
NG
How is nutrition provided to someone post op esophagectomy typically?
Jejunostomy (GT) typically
If no anastomotic leak then we progress the diet.
If there is then rest and retest
Why do we use large bore NG post-op Gerd and hiatal hernia surgery?
- allows opening to stay open
- helps us monitor drainage (we want yellowish green eventually)
What is the FIRST sign of esophageal tumor-cancer?
Dysphagia
What are the top 4 signs of esophageal tumor-cancer?
- Dysphagia
- Weight loss
- odynophagia (pain when swallowing)
- Hoarseness - with vocal cord invovlement
Is esophageal tumor curative?
sometimes yes- with surgery
Often still terminal after surgery so palliative approach is necessary
What things can we do as part of the palliative approach to esophageal cancer diagnosis?
assess for Anxiety and depression
Maximize quality of life
Realistic planning
Opportunity to grieve
Hospice care, etc
Why do we insert NG post fundoplication?
to prevent closure of the LES
How long must someone be on a liquid diet post fundoplication?
4-6 weeks
Is a person required to be NPO post fundoplication?
No
Is a person required to be NPO post esophagectomy?
YES!
How long do we do NPO and jejunum feeding post esophagectomy before trying oral?
about 1 week
Is fundoplication performed by laparotomy or laproscopic?
Laproscopic
Is Esophagectomy performed laparotomy or laproscopic?
Laparotomy
